How Nurse ‘Alarm Fatigue’ can Affect Patient Care

Nursing ranks as one of the largest professions in the United States, with more than 2.7 million people working in the field.

That number is expected to rise to more than 3 million by 2024, according to federal projections.

However, as attractive as the profession is for many, it comes with a unique set of difficulties. They include long hours, high stress, tension in the workplace and dealing with often difficult people experiencing some of the worst times of their lives.

Add to the list yet another issue: alarm fatigue.

The phrase refers to the bedside alarm patients ring when they need assistance or the automated alarms associated with electronic monitors, such as an ECG. For anyone who has ever been in a hospital or sat with a recovering loved one, a nurse’s response time often varies from alarm to alarm.

Alarm fatigue helps explain why that is.

Time of Day Matters

Alarm fatigue is a catch-all phrase to describe a situation in which nurses, hit by a barrage of alarms throughout a long shift, eventually become desensitized to them and fail to respond as quickly as they otherwise might.

A 2017 study from JAMA Pediatrics shows it’s not simple. The study found many reasons that might explain why a nurse might not respond “stat” when hearing the alarm. The study was conducted for 16 months at The Children’s Hospital of Philadelphia.

One of the main factors in response time was the timing of the alarm. By the end of a long shift, nurses have heard alarms frequently. The study found that response times were much faster toward the beginning of a shift. By the end of the shift, the constant demand of the alarms coupled with tiredness slowed response times.

That seems like common sense – a tired nurse is a slower-to-react nurse. That provides a neat definition and cause for alarm fatigue. However, the study found other factors.

Researchers found nurse response times were faster under the following conditions:

The nurse had less than one year of experience

The nurse had to care for just one patient

The nurse had previously responded to the patient’s alarm for something that required intervention

The nurse was responding to a lethal arrhythmia

Overall, the study found nurses responded in less than a minute to the lethal situation. But for about half of the other 11,745 alarms during the study, the response time was 10 minutes or more.

Other Factors

A varied list of factors can contribute to slower nurse responses times.

As the results on the fastest response times shows, nurses working with fewer patients responded faster. Nurses with one patient responded in 3.5 minutes on average, while those with two or more took more than 10 minutes.

Experience level of the nurses also played a role. More experienced nurses develop an intuition for how fast they need to respond, typically depending on the severity of the patient’s condition. Younger nurses tended to respond faster.

Interestingly, nurses of all ages respond faster when family is not around. A patient alone waited an average of 6.3 minutes for a nurse to arrive. Those with family members in their room waited 11.7 minutes on average.

Dealing With Alarm Fatigue

Even experienced nurses who develop a sense for what alarms need immediate attention run the risk of endangering a patient. That has led to studies into ways to deal with the issue.

Unfortunately, increasing staffing is not always a possibility at budget-conscious hospitals. However, the federal Department of Health and Human Services released a report that offers some suggestions.

One is that automated alarms often go off when there is not an issue that requires intervention. The HHS report found that 80-99 percent of ECG alarms are false or clinically insignificant. Some of this is due to the equipment not getting property placed on the patient. Some are due to the settings on the machine not matching the condition of the patient.

HHS suggested each hospital review the settings for monitoring devices rather than just using the default positions. Patients with different conditions will have a different parameter for when the situation requires a nurse. Some hospitals have even limited monitoring on non-critical patients to reduce the amount of alarms nurses must answer.

Also, educating staff on these issues can help decrease the number of automated alarms. Patient education also plays a role, with HHS recommending that patients be taught the need and function of various alarms.

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